Corticosteroid — Intralesional Scar Treatment Pregnancy: Triamcinolone crosses the placenta. Corticosteroids given to pregnant animals can cause abnormalities of foetal development; in man there is no evidence of an increased incidence of congenital abnormalities, but prolonged or repeated administration during pregnancy may increase the risk of intra-uterine growth retardation. Neonatal hypoadrenalism may theoretically occur after prenatal exposure but usually resolves spontaneously. Prescribe only when the benefits to mother and child outweigh the risks. Breast-feeding: corticosteroids may pass into breast milk (no data specifically for triamcinolone); infants of mothers taking high doses of systemic corticosteroids for prolonged periods may have a degree of adrenal suppression.

Triamcinolone Acetonide (Intralesional — Keloid/Scar)

Brand names: Kenalog, Adcortyl in Orabase

Intralesional triamcinolone acetonide is a long-acting corticosteroid injected directly into keloid and hypertrophic scars to flatten and soften them and to relieve associated itch and pain.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: Intradermal dosage is usually 2-3 mg (0.2-0.3 ml of the 10 mg/ml injection), depending on the size of the lesion

Route: Intradermal injection (the product is for intra-articular or intra-dermal injection ONLY; strict aseptic precautions should be observed)

Frequency: The injection may be repeated if necessary at one or two week intervals; since the duration of effect is variable, subsequent doses should be given when symptoms recur and not at set intervals

Max: No more than 5 mg (0.5 ml) should be injected at any one site; if several sites are injected the total dosage administered should not exceed 30 mg (3 ml)

Fetched UK SPC is Adcortyl Intra-Articular/Intradermal Injection 10 mg/ml (https://www.medicines.org.uk/emc/product/1410/smpc). NOTE ON INDICATION: §4.2 does not name keloid or scar — the figures above are the SPC's general INTRADERMAL dosing 'depending on the size of the lesion'. Confirm the keloid/scar indication and the intended product strength before publishing. For comparison, the intra-articular doses in the same section (a different route, not for this page) are 2.5-5 mg (0.25-0.5 ml) for smaller joints and 5-15 mg (0.5-1.5 ml) for larger joints. The SPC notes that triamcinolone acetonide 40 mg/ml (Kenalog) is available to facilitate administration of larger doses — that is a 4x more concentrated product and volumes are not interchangeable. SAFETY (§4.4): several instances of blindness have been reported following injection of corticosteroid suspensions into the nasal turbinates and intralesional injection about the head; cases of serious anaphylactic reactions and anaphylactic shock, including death, have been reported with triamcinolone acetonide injection regardless of route; skin effects listed in §4.8 include skin atrophy, skin fragility, hypo- and hyperpigmentation, striae and injection site reactions — all directly relevant to intralesional scar use. Elderly: treatment, particularly if long term, should be planned bearing in mind the more serious consequences of corticosteroid side effects in old age (osteoporosis, diabetes, hypertension, hypokalaemia, susceptibility to infection, thinning of the skin); close supervision is required. Paediatric (no per-kg dose is stated): Adcortyl is not recommended in children under 6 years; it may be used in older children in suitably adjusted dosages, with growth and development carefully observed on prolonged corticosteroid therapy, and caution in the event of exposure to chickenpox, measles or other communicable diseases — verify any under-18 dose against a children's formulary. The US cross-check label fetched (Trilona, Skya Health) is a TOPICAL triamcinolone cream/ointment and its 'apply a thin film two to four times daily' directions are for a different route — do not carry them onto this page.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

Hypersensitivity to any of the ingredients
Systemic infections, unless specific anti-infective therapy is employed
Administration by intravenous, intrathecal, epidural or intraocular injection
Intra-articular injection in the presence of active infection in or near joints; not to be used for joint pain arising from infectious states such as gonococcal or tubercular arthritis

Side effects

Injection site reaction (common); injection site irritation or discomfort, sterile injection site abscess, impaired healing (uncommon)
Skin atrophy, skin fragility, skin hypo- and hyperpigmentation, skin striae, petechiae, ecchymosis, erythema, purpura, acneiform dermatitis, hirsutism (uncommon)
Infection (common); masked infection, tuberculosis, candida infection, viral or fungal eye infection (uncommon)
Anaphylactoid reaction, anaphylactic reaction, anaphylactoid shock (uncommon)
Cushingoid appearance, adrenal suppression, secondary adrenocortical insufficiency, hyperglycaemia and loss of diabetic control, fluid and sodium retention (uncommon)
Eye disorders including blindness, cataract, glaucoma, corneal perforation and papilloedema (uncommon); blurred vision and central serous chorioretinopathy (frequency not known)

Clinical monograph

How it works

Within the scar it suppresses fibroblast proliferation and collagen synthesis, increases collagen breakdown and dampens local inflammation, reducing the excessive extracellular matrix that characterises keloid.

Prescribing in practice

Inject precisely into the scar substance and avoid the surrounding normal dermis and subcutis, as misplaced or excessive injection commonly causes skin atrophy, telangiectasia and hypopigmentation.
It is frequently combined with other modalities such as pressure, silicone or cryotherapy, and repeated courses are usually needed at intervals.
Do not inject into infected skin, and use caution over very large lesions where cumulative steroid load and local adverse effects increase.

Monitoring

Monitor the treated scar for thinning, depigmentation or telangiectasia and assess response over successive treatment sessions.

Counselling the patient

The injection is given into the scar itself to flatten and soften it, and several sessions are often required.
The skin over and around the scar may thin, lighten or develop fine vessels.
Report any signs of infection or unexpected skin changes at the site.

Evidence & guidelines

Intralesional corticosteroid is a long-established first-line treatment for keloid and hypertrophic scars in plastic surgery practice.

Reference: BAPRAS Keloid and Hypertrophic Scar Management Guidelines; International Advisory Panel on Scar Management 2014; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Calculators